How to Have a Natural & Gentle Cesarean

One of the single most difficult moments of my life was as I was being wheeled down the hall to an emergency c-section and I hugged my husband good-bye and we said our “I love yous.” He was able to rejoin me just as our little one entered the world, but that day and its difficulties are a painful whirlwind in my memory.

That c-section has been good for me as a mother and as a doula. It was humbling and difficult, but it taught be so much.

A Gentle Cesarean?

As grateful as I (now) am for that experience, there are so many things I wish I could do differently for the sake of our son. I hadn’t read any of the books about c-sections because I thought I’d never have one and I wasn’t at all prepared.

Because he was early, he spent 8 days in the NICU and I didn’t get to hold him until the end of that time. I had to pump and he was fed through a bottle or a feeding tube. We didn’t get skin to skin and he definitely didn’t get any beneficial bacteria from me after birth. (As a side note, I’m smiling in that picture because of the happy drugs they gave me since the epidural didn’t work, not because I had a gentle birth!)

After my own c-section I started researching gentle c-sections and how to optimize factors in the event that a c-section is necessary. Having been through it myself, I know how difficult it is, and I wanted to find ways to help other women have a more gentle time (and an easier recovery).

I’ve now had the privilege to be a doula at several cesarean births and to help implement these ideas and I’ve seen the benefit to mom and baby. It is too late for me to have implemented this with my own son at the time of my c-section, but I hope that what I’ve learned since then might be helpful to some of you.

Obviously, natural birth is optimal whenever it is possible (and it is possible much more than the 30+% that it occurs now) but there are times where it is legitimately not possible to deliver vaginally (like my placenta previa) and there are ways that we can make the best of that situation for mom and baby.

Skin to Skin & Bonding

One important aspect that is lost in many c-section births is the vital skin to skin time with mom and baby. I didn’t get this with our son because he was having a slight trouble breathing. I really wonder if we’d had even just a minute of this, if his breathing might have improved and he would not have needed the time in the NICU (some research is showing this is a possibility).

For example, Dr. Camann realized that by using both clear and solid sterile drapes, obstetricians could switch the solid drape for the clear one just before delivery and allow mom to see her baby being born. “We also allow mom a free arm and place the EKG leads on her back so that she is able to hold, interact, and provide skin-to-skin contact with her baby in the moments following the birth,” said Camann, who teamed up with BWH registered nurse Kathy Trainor, to make this option available to patients and their families.

Kathy Trainor notes that research has shown that techniques such as skin-to-skin contact have important benefits for a mother and her baby.

“Allowing mom and baby to bond as quickly as possible after the delivery makes for a better transition for the baby, including better temperature and heart rate regulation, increased attachment and parental bonding and more successful rates of breast feeding,” she said. (source)

Research is now showing that this skin to skin contact immediately after birth is important for culturing baby’s gut bacteria and microbiome properly.

Microbiome

Perhaps even more important for baby’s health long term is the need to properly develop the microbiome. An excellent new movie called Microbirth delves into the way a baby’s gut bacteria is cultured during the birthing process and how this affects the baby throughout his or her life and can even affect things like cancer and heart disease risk later in life.

The movie points out that a baby born via c-section has 1/3 less variety of bacteria in his or her gut than the gut of a baby born vaginally in an optimal environment. This seems especially disheartening and scary, especially to moms who have no choice but to have c-sections, but the movie also offered some unconventional advice and some hope…

One of the doctors interviewed in the documentary explained how they were able to create the same variety of healthy gut bacteria in a baby born via c-section. They inserted a sterile gauze into the mother’s birth canal for the hour or so before delivery (by c-section). In the time before birth, the mother’s body will culture trillions of bacteria in the birth canal that are passed on to baby as he or she is born. Of course, this transfer doesn’t happen in a non-vaginal birth but this offered a work-around.

The sterile gauze was removed from the mother just before the baby was born and placed in a sterile container. As soon as baby was born, the gauze was wiped in the baby’s mouth, nose, and all over the face and skin of the entire body. This exposed the baby to the mother’s beneficial bacteria first and in a five year follow-up, babies who went through this process had similar gut bacteria to babies born vaginally and had lower rates of obesity, allergies, eczema and more.

It sounds strange, especially at first, but it certainly isn’t any more strange than the way the transfer happens during a vaginal birth where baby comes fully in contact with the bacteria in the birth canal, getting it in his or her mouth and nose.

I highly recommend the movie Microbirth to any expecting parents, but especially to those who must deliver via c-section. I’m purchasing several copies to pass on to doctors I know to spread the word about this important topic. As Toni Harman explains:

As the fetus grows in the womb, it develops in a near-sterile environment relying on its mother for protection. But when the baby emerges, it is entering a world of bacteria, some of which are bad (pathogens) but some of which are good.

In the weeks and days leading up to birth, specific species of good bacteria are migrating to key locations in the mother’s body and are transferred to the baby during and immediately after birth via the birth canal, immediate skin-to-skin contact and breastfeeding. The role of these good bacteria is to train the baby’s human cells to distinguish between what is “friend” and what is “foe” so that its immune system can fight off attack from pathogens. This process kickstarts the baby’s immune system and helps to protect the infant from disease for its entire lifetime.

However, with interventions like use of synthetic oxytocin (Pitocin / Syntocinon), antibiotics, C-section and formula feeding, this microbial transfer from the mother to baby is interfered with or bypassed completely. For babies that enter the world by C-section, their first contact could be with bacteria that is resident in hospitals and from strangers, i.e. not with the special cocktail of bacteria from the mother.

The latest scientific research is now starting to indicate that if the baby is not properly seeded with the mother’s own bacteria at birth, then the baby’s microbiome, in the words of Rodney R Dietert, Professor of Immunotoxicology at Cornell University, is left “incomplete”. Consequently, that baby’s immune system may never develop to its full potential, leaving that infant with an increased risk of developing one or more serious diseases later in life.

This area of research is very much still in its infancy but as research develops, I know many families that are attempting this method of culturing baby’s gut bacteria since there is no documented downside and baby would naturally encounter these bacteria during birth anyway. Baby is usually wiped off and dried anyway, there isn’t a reason this could not happen with a gauze that had been exposed to the mother’s gut bacteria.

A Gentle Cesarean Birth Plan

When c-sections are needed and especially pre-planned, there are some factors that families can discus with their doctors and birth team to try to create a more gentle environment if circumstances allow. Things like:

Dropping the drape or using a clear drape so that mom can actually witness the birth of her baby (especially since she won’t be able to see the incision because of its placement

Immediate skin-to-skin once baby is born and while mom is being repaired if possible. If not, dad can have skin to skin with baby while mom is being repaired.

Fostering of the early nursing relationship by having baby on mom’s chest during the rest of the procedure so baby can start to nurse if he/she desires

Using a specially cultured gauze to swab the baby and expose him/her to mom’s beneficial bacteria

Letting the dad cut the cord if circumstances allow

Keeping mom, dad and baby together in the recovery unit to let nursing and bonding happen

Allowing for an extra person (doula, grandparent, etc) to be there to photograph the birth so that mom and dad can both interact right away

Have music of choice playing if possible

Having all IVs, straps, etc on the non-dominant arm so that mom can touch and hold baby once he or she is born

Performing all newborn tests on mom’s chest if possible

Ensuring that all medications are approved for breastfeeding, if possible

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